Healthcare Provider Details

I. General information

NPI: 1285092106
Provider Name (Legal Business Name): HARVEST RETIREMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2016
Last Update Date: 02/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 KNOTT AVE
BUENA PARK CA
90620-4138
US

IV. Provider business mailing address

9011 KNOTT AVE
BUENA PARK CA
90620-4138
US

V. Phone/Fax

Practice location:
  • Phone: 714-821-4130
  • Fax: 949-608-1588
Mailing address:
  • Phone: 714-821-4130
  • Fax: 949-608-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number306005207
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number306005207
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number306005207
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number306005207
License Number StateCA

VIII. Authorized Official

Name: MRS. GINGER PO
Title or Position: PRESIDENT
Credential:
Phone: 949-648-2737